FINAL EXAM NOTES-HS 1001 PDF

1001 ch1 : taking charge of your health lesson outcomes: - describe health, wellness, 9 dimensions of wellness - differentiate bw infectious + chronic diseases - explain life expectancy and major health threats - explore the concept of health behavior change...

1001 ch1 : taking charge of your health lesson outcomes: - describe health, wellness, 9 dimensions of wellness - differentiate bw infectious + chronic diseases - explain life expectancy and major health threats - explore the concept of health behavior change health + wellness - world health organization : state of complete physical, mental and social well-being; not merely the absence of disease or infirmity. - ottawa charter : resource for everyday life, not the object of living. health is a positive concept emphazing social and personal resources, as well as physical capacities - social determinants play a key role in health of groups - peace, shelter, education, income, social justice what is wellness? - expanded idea of health - determined by the decisions you make about how you live your life - the ability of live fully, with vitality and meaning - a dynamic process of change and growth→ not a static goal - improving one area of life often helps another - encompasses at least 9 interrelated dimensions - physical health ≠ wellness 9 dimensions of wellness 1. physical wellness - healthy eating, exercise, regular check-ups, etc. - personal responsibility of health + signs of illness - influences quality of life and life expectancy ** health-related quality of life : a personal sense of physical and mental health→requires a full range of functional capacity to enable people to work, play and maintain satisfying relationships 2. emotional wellness (heart) - optimism, trust, self-esteem, an ability to share feelings and having satisfying relationships - requires monitoring feelings, identifying obstacles to emotional wellbeing, finding solutions to emotional problems - how we work for emotional wellness  - self help and professional help 3. intellectual wellness - an openness to new ideas, a capacity to think critically and to learn new skills - the ability to process and use info 4. interpersonal / social wellness - learning effective communication skills, developing the capacity for intimacy, and cultivating a support network - requires participating in and contributing to your community + society - interactions w/in your community - healthy relationships in ur life - social network - acceptance of diversity 5. cultural wellness - the way individuals interact w other who are different from them in terms of ethnicity, religion, gender, sexual orientation, age, customs - building positive relationships, and accepting/valuing all individuals - tuning into your own cultural background 6. environmental wellness - personal health depends on the health of the planet (violence, safety of food supply, pollution) - learning about and taking actions to protect yourself as well as the community and planet - connection to your own personal environment - personal surroundings being cared for - personal environmental wellness - being aware of earth’s natural resources - being environmentally friendly - creating supporting environments for yourself 7. spiritual wellness - having a set of guiding beliefs, principles, or values that give meaning and purpose to one’s life - not necessarily religion - values that guide your actions - capacity for love, compassion forgiveness, joy, altruism - a resource for ↓ personal stress 8. financial wellness - ability to live within your means and manage your money - balancing income and expenses, saving for the future, understanding emotions about money - taking control of financil decision making 9. occupational wellness - sense of personal satisfaction derived from career/personal development - attaining work-life balance - giving yourself breaks infectious vs chronic diseases infectious diseases : diseases caused by pathogenic microorganisms (bacteria, viruses, parasites, fungi) - communicable from environment/person-person - tuberculosis - influenza - common cold - hiv, sars - sars-cov2 (covid) - covid : third leading cause of death in canada + contributed to ↓ in health and life expectancy - exacerbates other causes of death (cancer + chronic diseases) - may 2023→no longer a public health emergency of international concern - 2024 review→large worldwide surge in common communicable diseases - influenza, measles tuberculosis, whooping cough (since 2022) - must learn how to adapt and alter our behaviours to protect ourselves + others layered approach : no single control measure is 100% effective on its own ace health and safety controls - provides the strongest protection against transmission of respiratory infectious diseases - with each added layer of control, the risk of transmission gets lower - vaccination, staying home, ventilation, masking, covering coughs/sneezes chronic diseases : develop and become worse over a period of time, caused in part by lifestyle factors - cancer - heart disease - stroke - not everyone is able to make the same health behaviour choices, due to personal determinants of health  life expectancy + major health threats early 1900s - life expectancy - 58.8 yrs (M), 60.6 yrs (F) - leading causes of death : infectious diseases (cholera, tuberculosis, pneumonia) - spread due to lack of clean water, poor sewage removal, crowding, unsanitary food prep - growing trade b/w countries moved diseases from one to another - sources of infectious disease soon discovered - public health emerged as being critical to controlling the spread of disease - adoption of vaccinations and development of antibiotics allowed western society to control the major causes of morbidity(illness/disease) and mortality(death) - ppl began expecting that modern medicine could conquer any illness canada today - life expectancy - 80 yrs (M), 84 yrs (F) - predicted extra years after age 65 : 19 yrs (M), 22yrs (F) - chronic diseases (cancer + heart diseases) - 2 leading causes of death + disability (>40%) - some risk factors fall w/in the realm of a person’s lifestyle chronic/non-communicable conditions *** best course of action : prevention - better to be prevented before hand instead of relying on medicine to fix it afterwards - having control over whether they develop certain conditions/diseases - ex. smoking is the leading preventable cause of death, followed by poor diet, inactivity, alcohol use health behaviour change common health goals: - weight management, quit smoking, ↓ caffeine/alcohol consumption, ↓ stress, better sleeping habits, ↑ fitness, better eating, strengthen relationships why behaviour change is difficult individuals must: 1. know that a behaviour is associated with/causes a health problem 2. believe + accept that the behaviour makes them susceptible to this health problem 3. recognize that risk-reducing strategies exist that can ↓ their risk for the health problem 4. believe that the benefits of the newly adopted behaviours will be more reinforcing than the behaviours they're giving up 5. feel that significant others want them to alter their high-risk health behaviours and will support their efforts - successful prevention of health-risk behaviours is ↓ when any one of these conditions is not in place - behaviour change is complex - support + info are important how to change health behaviours - knowledge is a necessary ingredient, but not enough - requires motivation + support 1. examine pros and cons of change - benefits must be believed to outweigh costs for success 2. boost self-efficacy - your belief in your ability to successfully take action and perform a specific task - develop internal locus of control (source of responsibility) - use visualization and self-talk - obtain social support/find role models 3. identify and learn how to overcome barriers to change - make a list if obstacles and develop strategies to overcome them transtheoretical behaviour change model - developed based on 6 predictable stages in which people with long-standing problem behaviours moved - important to know what stage people are at so strategies can be used to help guide people through the remaining stages of change. 1. precontemplation : no attempt of changing behaviour w/in next 6 months 2. contemplation : awareness of problem - think + learn ab behaviour and its consequences - see themselves taking action w/in next 6 months - unsure how to proceed - strategies : looking at pros/cons + how to overcome barriers; self efficacy 3. preparation - plan to take action w/in a month - may have started making small changes - strategies : creating plan for behaviour change 4. action - plans for change are implemented  - changes are made and sustained for ~6 months - risk for reverting to old behaviour 5. maintenance - maintained new behaviour for at least 6 months - 6 months→ 5 years - ↑ confidence + self-efficacy 6. termination - exit from cycle of change - new habits are well established and efforts to change are complete - no longer tempted to lapse into old behaviour - new self-image and complete self-efficacy other tips for behaviour change - tackle one area at a time - tackle easier areas first - staying informed - create a wellness-supporting environment 1001 ch2 : psychological health lesson outcomes: - describe what it means to be psychologically healthy - explain how to develop and maintain a positive self-concept of healthy self-esteem - describe common psychological disorders - develop an understanding of and list the warning signs of suicide - describe the prevalence of and factors associated with mental health problems among university students - describe the models/approaches used to treat psychological disorders - list and become familiar with the important mental health resources what it means to be psychologically healthy what is psychological health? psychological health is NOT : - psychological normality - ** psychological diversity is valuable - determined on the basis of symptoms alone  - ex: anxiety, stress, sadness - determined from the way people look psychological health is: - the absence of (mental) sickness - narrow definition; you don't have to have a diagnosed mental illness to be psychologically unhealthy - or people with diagnosed mental illnesses can feel psychologically healthy - the presence of mental wellness - more broad - freedom of mental diagnoses is only a small part - our capacity to think, feel and behave in ways that contribute to our ability to enjoy life and manage challenges maslow’s hierarchy of needs fulfilment of human potential help understand basic needs, psychological health and motivation advanced a hierarchy of needs in order of urgency urgent needs satisfied before less urgent ones take priority - physiological → emotional described an ideal of mental health - studied “psychologically healthy” ppl who have lived successful and full lives 1. physiological : basic biological needs 2. safety + security : protection 3. love + belongingness : meaningful relationships +belonging 4. self-esteem : sense of selves 5. self-actualization : sense of being self-actualization those who make it to the top of the needs hierarchy achieve self-actualization - fulfilled human potential - highest level of growth self-actualized individuals = psychologically healthy individuals qualities : - realism : being realistic and being able to deal with the world as is - acceptance : positive + realistic self image - autonomy : directing yourself and being independent + self-efficacy - capacity for intimacy : physical + emotional - creativity : emotionally open characteristics of psychological health  high levels of openness to feelings → being able to experience and express emotions - warmth - positivity - straightforwardness - competence - altruism : unselfish concern of the welfare of others hostility, depressiveness, impulsivity, anxiousness found less what it means to be healthy : striking a balance in all aspects of ur life - realising it's ok not to have balance all the time resilience → the ability to recapture a sense of psychological wellness within a reasonable time after encountering a difficult situation ** emotionally well ppl aren't perfect but what distinguishes them = being able to bounce back (eventually) self-concept and self esteem developing a positive self-concept feeling better about ourselves and better about being in the world (self image) begins in childhood by feeling loved, feeling that one can give love, and having a sense that one can accomplish goals - we have to believe that our behaviours and actions can result in good things for us - what happens in our life depends on sturdiness of sense of self integration : feeling that one has created their own self concept rather than adopting an image that others have created – developing and being in charge of who you are stability : the integration of the self and its freedom from contraindications (disruptions) **importance of foundation of strong self concept at an early age self-esteem regarding all aspects of urself as good, competent, and worthy of love critical component of psychological wellness - exhibit characteristics of psychological health; cope well, get along well, comfortable with own thoughts/feelings ↓SE may offer destructive behaviours ↑SE means finding a balance between your idealised and current self acceptance, understanding and a sense of who you are - on top of having realistic goals foundations of SE can be traced to childhood hardiness ability to handle change with grace + control over your life  works with SE to enhance psychological health exists when a person shows : 1. a high level of commitment - basis of values and sense of purpose - maintaining helps provide structure and direction 2. a sense of control - a ability to orchestrate the events in their lives - prevent feeling helpless in the face of change 3. welcome challenge - take control of change and use it to enhance their growth/fulfilment psychological disorders generally the result of many factors (genetic differences, trauma, learned behaviours, life events parental/peer influences) - emotional problems distress/anxiety are regular responses to life's challenges - when they interfere w our lives, they may be considered symptoms of psychological disorders anxiety disorders most common psychological disorders among canadians fear is a tool for self-protection – problematic when it is too prominent differentiated from daily stress bc the feeling is : - intense, often debilitating - long-lasting, persisting after the danger has passed - dysfunctional, interfering with life simple (specific) phobia most common type definite - persistent and excessive fear of a specific thing, activity, situation can originate in bad experiences social anxiety disorder intense fear of being embarrassed or evaluated negatively by others results in avoidance of social situations - negative impact of work/school performance, and relationships - not introverted - often desire social interactions panic disorder characterised by panic attacks → individuals experience severe physical symptoms accompanied sudden unexpected surges of anxiety  - can occur out of the blue or due to triggers may lead to agoraphobia : fear of being alone and away from help, and avoidance of many different places/situations; or fear of leaving home (sheila) generalized anxiety disorder (GAD) characterised by excessive, uncontrollable worry about all kinds of things anxiety in many dif situations - persistent, every-day nervousness - may lead to depression obsessive-compulsive disorder (OCD) characterised by - obsessions (recurrent intrusive thoughts or impulses causing distress) - compulsions (repetitive behaviours aimed at reducing anxiety associated w the obsessions) take over ppls lives behavioural addictions activity or behaviour that is maladaptive and persistent despite the negative consequences - compulsion is small but significant intense urges to engage in behaviour are anxiety evoking and intensifying until they carry out the behaviour for relief and elation post-traumatic stress disorder (PTSD) reaction to severely traumatic events that produce a sense of terror and helplessness characterised by reliving traumatic events through dreams, memories, hallucinations - accompanied by numbness of feelings, sleep disturbance, withdrawals, symptoms of anxiety/depression treating anxiety disorders can include - medication (anti-anxiety meds) - psychological interventions (cognitive behavioural therapy) - stress management and coping techniques - exercise, nutrition, avoiding stimulants (caffeine) mood disorders emotional disturbances that are intense and persistent enough to affect daily functioning - relationships, wellbeing, physical health, behaviour - hard to bounce back depression most common + treatable mental illness  affects ~11% of canadians 15+ women are 2x as likely as men - takes many forms but usually involves a sense of feeling demoralised, and includes : - a feeling of sadness and hopelessness - loss of pleasure in doing usual activities - poor appetite/weight loss - insomnia/disturbed sleep - restlessness or fatigue - thoughts of worthlessness and guilt - trouble concentrating or making decisions - thoughts of death or suicide dysthymic disorder tend to experience persistent symptoms of mild or moderate depression for 2+ years persistent depressive disorder can still have periods of major depression depression in disguise sometimes people who live with depression don't show “typical” signs - some ppl may have extended periods of irritability or anger rather than sadness - makes diagnosis more difficult depression in older adults is often viewed as “normal” - living with ongoing feelings of grief and hopelessness is not an inevitable part of aging children and youth who live with depression experience symptoms much differently - may complain of sickness, avoid school, or be extremely reluctant to leave apart - may come across as angry, uncooperative anti-social or irritable can be difficult to separate a child’’s clinical depression from a “phase” *** important that adults around them are aware treating depression ~80% of individuals respond well to treatment, but only ~10% of ppl living with depression will seek treatment - shame + stigma available and accessible treatments : antidepressant meds, counselling, psychotherapy recovery within two years is common although never assure - med effectiveness + timeline is dif for everyone mania + bipolar disorder mania : excessive elation, irritability, talkativeness inflated self-esteem and expansiveness  bipolar disorder : swing bw manic and depressive states - tranquilizers used to treat manic episodes and special drugs to prevent mood swings schizophrenia disturbance in thinking and in perceiving reality - disorganised thoughts - inappropriate emotions - delusions - auditory hallucinations - deteriorating social and work functioning characteristics are not invariably present; can be logical minus delusions, or disorganised thoughts with no delusions understanding suicide suicide one of the principal dangers of severe depression suicide attempts can occur unpredictably and unaccompanied by depression, but chances of suicide are greater if symptoms are numerous and severe ~4500 ppl in canada die each year due to suicide second leading cause of death among youth and young adults - suicide is often thought to be related to depression, anxiety, substace use; however any mental illness can increase the risk - may not be related to just one illness recognizing warning signs / predisposing factors : - history of previous suicide attempts) - suicide by a family member or friend - a serious physical or mental illness - history of substance abuse or eating disorders - a major loss, such as the death of a loved one, unemployment, or divorce - major life changes or transitions - social isolation or lack of a support network - access to the means of suicide - expressing the wish to be dead - increasing social withdrawal suicide + language using appropriate, non-stigmatizing language is important - avoid : “commit suicide” “successful suicide” “failed suicide attempt” - use : “die by suicide” “non-fatal suicide attempt” mental health problems student mental health requires a whole community approach - governments, health care providers, community agencies, post-secondary settings ontario university students factors negatively impacting academic performance - stress = 51.5% - anxiety = 43.3% - depression = 30.4% 33.4% were categorised as being in “serious psychological distress” 32.0% reported “ever” being diagnosed with anxiety 24.6% reported “ever” being diagnosed with depression **problems appear before the age of 25 approaches to psychological disorders stigma : set of negative and often unfair beliefs that a society or group of people have about something leads to : - discrimination subtle judgements - to a reluctance to seek help - lack of understanding from others - fewer opportunities from work, school or social settings - belief that one will never succeed models of human nature and therapeutic change 1. biological (medical) model the mind’s activity depends on the brain and its genetic composition still acknowledges the influence of environment and learning focuses on the activity of neurons and complex chemical rxns illness due to a biochemical imbalance - treatment : pharmacological 2. behavioural model focuses on what people do rather than on brain chemistry behaviour is learned and changed behaviour is analysed in terms of stimulus, response, and reinforcement - treatment : aim to discover what reinforcements sustain an undesirable behaviour and then to alter those reinforcements (exposure therapy) 3. cognitive model behaviour results from complex attitudes, expectations and motives rather than simple reinforcements individuals taught to substitute their unrealistic thoughts w realistic ones and to test their assumptions - treatment : therapy tries to expose and identify false ideas that provide anxiety 4. psychodynamic model emphasises that thoughts and unconscious emotions, ideas and impulses that direct our thoughts and behaviours (freud) emphasises the role of the past in shaping the present - therapy : patients speak freely to understand the basis of their feelings and try to gain insights 5. combined approach : cognitive-behavioural therapy (CBT) focuses on changing problematic patterns of thinking involves individual and group sessions with a therapist has been shown to produce significant improvements has been combined with drug therapy for depression and anxiety disorders  ch3 : stress explain what stress is and how people react to it - physically, emotionally, behaviorually describe the relationship bw stress and disease list the short and long term impacts of stress on health explore different perspectives on and our reactions to stress decsribe techniques for preventing and amanaginbg stress and create a stress management plan stress isnt what happens, its our response - meaning we can choose + control what is stress stress : the general physical and emotional state that accompanies a stress respomse 1. situations that trigger physical + emotional reactions - stressors 2. the reactions themselves - stress response responses to stressors the primary determinant of health consequences of stress is how the indivual responds to the stress responses include : 1. physical changes 2. emotional and behavioural responses physical responses two control systems are repsonsible for the physical responses to stressors: - nervous system - endocrine system prepare body to respond quickly in times of danger nervous system autonomic nervous system - basic body process - part that is not under conscious supervision (somatic) - consists of two divisions a) parasympathetic in control when you are relaxed digestion, growth, storing energy - during stress, these symptoms are slowed to maintain homeostasis b) sympathetic activated during arousal and emergency situations releases norepinephrine which commands body to mobilize energy resources to respond to crsis and causes arousal when released in the brain - ↑ attention and alertness - accelerates body processes endocrine system system of glands, tissues and cells that help control body fucntions by releasing hormones and other chemical messengers into the bloodstream - prepares the body for a stressor brain detects threat neurochemical message sent to hypothalamus which releases chemicals to pituitary gland which releases adrenocorticotropic hormone (ACTH) into bloodstream ACTH reaches adrenal glands which release cortisol and other key hormones into bloodstream simultaneously, sympathetic nerves instruct adrenal glands to release the hormone epinephrine (adrenalin) which triggers several body changes - ↑ heart + respiration rates, acute hearing and vision, liver releases extra sugar to ↑ E, ↑ perspiration, brain releases endorphins Walter Cannon instantaneous changes referred to as fight or flight reaction physical changes vary in intensity, but the same physical rxns occur in pos vs neg stressors AND physical vs psychological stressors homeostasis : a state in which blood pressure, heart rate, hormone levels and other vital fxns are maintained w/in a narrow range of normal your body resists changes once a stressful situation ends, the parasympathetic division of the autonomic NS initiates adjustments necessary to restore homeostasis - body resumes normal fxns - any damage sustained during fight or flight is repaired fight or flight in modern life a biological survival mechanism not often necessary - many stressors do not require a physical response fight or flight prepares body for physical action regardless of whether it is a helpful response emotional + behavioural responses tend-and-befriend humans may respond to stress with social and nurturant behaviours tend : caring for offspring during befriend : engaging social network/support for help - especially for females - response to stress evolved to protect self and offspring - depends on underlying biological mechanisms and hormones (oxytocin) stress and disease 1. general adaptation syndrome (GAS) Hans Selye (1936) stressors can be pleasant, eustress, or unpleasant, distress ** physical response is same for both - three rxn stages 1. alarm phase (initial stressor) fight or flight response body is prepared to deal with crisis -> more susceptible to disease  headaches, indigestion, disrupted sleeping/eating 2. resistance (continued stress) new level of homeostasis resistance to disease is enhanced individuals can cope w normal life and added stress 3. exhaustion (prolonged stress exposure) considerable amount of resources utilised in previous stages result = physiological exhaustion + low resistance to disease distorted perceptions and disorganised thinking - body can return to homeostasis if energy resources are replenished criticisms : assigns a limited role to psychological factors - our belief, perspective and coping strategies are influential on stress assumes that responses to stress are uniform 2. allostatic load long term wear and tear of the stress response long term exposure to stress hormones linked w health problems - factors : genetics, life experiences, emotional/behavioural responses - high allostatic load linked w heart disease, hypertension, obesity, poor brain/immune fxns ** when someones allostatic load exceeds ability to cope, they're likely to become sick 3. psychoneuroimmunology (PNI) study of the interxns among nervous, endocrine and immune systems stress impairs the immune system - affecting health acute stress : enhancement of immune response chronic stress : negative effects on immunity - prolonged cortisol secretion -> inflammatory diseases stress and specific conditions short-term: colds and other infections, headaches, stomachache, allergies, etc. long-term: cardiovascular disease, high blood pressure, impaired immune function, Type 2 diabetes, cancer, psychological problems **chronic stress + poor stress-management leads to risk of health problems  perspectives on stress part of the neg impacts depend on your beliefs, perceptions, ability to cope, and seek help from others your cognitive appraisal of a stressor influences how you view it factors that reduce the magnitude are successful prediction and the perception of control personality is a contributor to how people perceive + react to stress - conscientiousness, agreeableness, neuroticism, openness to experience, extraversion stress prevention and managing you can minimize the impact of stress in your life by: strengthening your support system improving your communication skills being nurturing and kind to others developing healthy exercise, eating, and sleeping habits learning to identify and moderate individual stressors developing resilience - bouncing back from adversity - time management - relaxation techniques - mindfulness  Weight management and childhood obesity People first language - The standard respectfully addressing people with chronic disease, rather than labelling them by their illness - Important for bias and stigma associated with obesity (The boy with obesity was riding his bike → proper language) *Not a one-size fits all solution → some prefer identity-first language *since some people feel that this trait is a poor factor of their identity Prevalence/ stats - 54% of adults in Canada report that they live with overweight - 18% report that they live with obesity - Estimated that 70% of males and nearly 50% of females in Canada will be classified as having overweight or obesity What is obesity Video: obesity Canada Progressive chronic condition characterized by abnormal/ excessive fat accumulation that impairs health Leading to cause of type 2 diabetes, high blood pressure, heart disease, stroke, arthritis, cancer and other health problems Associated with pervasive social stigma Weight bias can increase morbidity and mortality, causes inequities in employment, healthcare and education In August of 2020 the obesity guidelines (most recent and quality based) (guidelines adapted and adopted by countries) released from obesity Canada described as a chronic disease (Canadien medical association), obesity characterized by a persons body fat not a persons size. Obesity only requires treatment when it threatens health Canadian clinical practice guidelines - Cmaj - Approach on obesity - Focusing on health rather than weight loss - Focuses on whether this persons excess body fat affects their health - Authors of this report: Ian patton (someone who experienced obesity, shares his insights) - Ian patton is director of advocacy and public engagment, obesity Canada Ian patton: Obesity Canada - Obesity Canada stands at the forefront of obesity managment in Canada, leading the way with evidence-informed resources, comprehensive guidelines, and a commitment to improvising the lives of Canadians effected by obesity. Through innovative research, education, and advocacy, Obesity Canada sets the national standard for excellence in addressing this critical public health issue. - BMI is how we classify obesity - We need to recognize that obesity is a chronic disease characterized by excess body fat affecting their health (more comprehensize approach) Obesity pathogenesis - Obesity pathogenesis involves complex biological, psychosocial, and environmental factors - Body weight is meticulously regulated by the brain - Obesity is influenced by the social and physical environment in which we live Treatment options THREE PILLARS OF OBESITY MANAGEMENT - Psychological interventions, pharmacological therapy and bariatric surgery - Physical activity and nutrition are not treatments themselves but they are parts of the treatment pathway International collaboration - It is undeniable that obesity is a complex, chronic disease - Obesity is dirvien by powerful underlying biology, not by choice - The many health effects of excess weight can start early - Obesity is treatable - Weight bias, stigma, and discrimination are harmful Weight bias Negative personal attitudes The problem is widespread In health case mostly Weight stigma Social sterotypes Weight-based discrimmination Actions (verbal, physical, relational) STIGMA→BIAS→DISCRIMINATION Impact on quality care Ambivalence about treatment roles Less time spent with patients and less discussion Reduced [reventative health services and exams and less intervention Patient experiences in healthcare - Inaccessible equipment and facilities - Embarrassment about being weighed - Unsolicited advice about losing weight - Receiving inappropriate comments about their weight - Being treated disrespectfully because of their weight Shaming is harmful and ineffective - Can make individuals feel stigmatized or shamed about their behaviours - Individuals with higher internalized weight bias report less weight loss - Shameful message will make the problem worse Key themes of obesity - Depressing, shameful, exhausting… Popular media images - Portray individuals with negative connotation which spreads weight bias - Often stereotyped as eating fast food and being lazy Obesity Canada - Obesity Canada provides individuals with ways that portray obesity in ways that are positive and not stereotypical Stigma - Negative stereotype - Also defined as a set of negative or unfair beliefs - weight bias refers to our own attitudes and beliefs about obesity Video - Needs to be addressed on an individuals level by educating others - Inventions to address social stereotypes - Prevent discrimination in other environments Widespread problem - In schools, workplaces, health systems and social media - Elementary school: kids with obesity face a 63% higher chance of being bullied - Adults: 54% of adults with obesity report being stigmatized by coworkers - Healthcare: 64% of adults with obesity report experiencing weight bias from a health care professional - Social media: 72% of images and 77% of videos stigmatized persons with obesity according to recent media studies HBO: Stigma- The human cost of obesity - Most of individuals in america experience obesity - In this video individuals talk about discrimination they have faced in society and their experiences - Obesity is a problem of society and how people treat others - Pervasive bias, relational victimization, cyberbullying, bias at home, bias at the doctors office, bias in the workplace, economic hardships - Gender and weight bias (harder for girls) - Women tend to be more vulnerable to weight bias - No federal laws that prohibit weight discrimination - Stigmatizing people actually motivates people to give up Childhood obesity - A serious global health concern - In Canada overweight and obesity have steadily increased among children - ~1 in 3 (31.4%) children and youth in overweight or obese categories (11.7%), compared to ~ 1 in 4 (23.3%) in 1978/79 - Almost 1 in 7 classified in obese category - * Linked to insulin resistance, type 2 diabetes, discrimination, v social well-being - * Tracks to adulthood → important to intervene during childhood Causes of childhood obesity - No singular cause of paediatric obesity - Complex interactions between a child and their environment - Associated with many personal, social, environmental, and political factors The weight of the nation-video - Children that are obese are much more likely to become obese as adults - Important to under that social media and adds can also portray obesity - Industry fosters eating, causes influences for children - Can lead to heart disease and diabetes in their mid 30s - Doctor tells sofia that her insulin levels were getting really high and poses her at a really high risk - Having a television in the bedroom has found to be associated with obesity (shown in Tiaras case)-not being physically active, and advertising about food - Described as, research distilled in three words, powerful, pernicious and predatory (food marketing) 1. From a societal and/or environmental perspective, what needs to happen to combat childhood obesity? - Not advertising fast food as much (food marketing) influences children to eat foods that affect their health - Drives the likelyhood of obesity Intervention - Childhood obesity tracks into adulthood - Simply the action or process of intervening Health intervention - Act performed for, with, or on behalf of a person or population whose purpose is to assess, improve, maintain, promote, or modify, functioning, or health conditions CHILDHOOD OBESITY INTERVENTIONS - “Interventions that are successful in the prevention and management of childhood obesity are urgently needed. - Multicomponent lifestyle programmes and strategies can be effective in reducing childhood obesity. For greatest success, these should be tailored to individual family needs.” THE CHILDREN’S HEALTH AND ACTIVITY MODIFICATION PROGRAM (“C.H.A.M.P.”) A Lifestyle Intervention for Children with Obesity Project description - Community- and family-based program for children with obesity and their families - 2-year pilot project funded by The Lawson Foundation (2008-2010) - Evaluates something new JOSEPH STORY Joseph story: an 11 year old boy struggling with weight, he was sent to a summer weight loss program. Most of the kids lost weight. He gained the weight back. This shows that weight loss is not the path to success there are much more factors associated with lifestyle perhaps. Community partnerships ➔ Canadian Centre for Activity & Aging ➔ YMCA of Western Ontario ➔ Middlesex-London Health Unit ➔ Children’s Hospital of Western Ontario ➔ Family Service Thames Valley ➔ Thames Valley Family Practice Research Network ➔ London Anti-Bullying Coalition ➔ Western Campus Community Police Service ➔ Field Trip Partners ➔ London Knights Hockey ➔ CCH Secondary School ➔ UWO Football ➔ Superstore Cooking School GENERAL PURPOSE - To develop, implement, and assess the effectiveness of a 4-week lifestyle intervention for children with obesity and their families SPECIFIC OBJECTIVES - To increase physical activity behaviour during and after the intervention - To improve physiological and psychological outcomes, as well as dietary patterns and self-efficacy Participant recruitment Physician referrals Newspaper articles and ads Radio interviews and ads Television interviews Posters displayed in community settings Project description Participants ◦ Year 1 (2008) - 15 children (8 females, 7 males), ages 8-14 ◦ Year 2 (2009) - 25 children (12 females, 13 males), ages 10-12 ◦ Body Mass Index (BMI) > 95th percentile for age and sex Intervention ◦ 4-week group-based (more likely to change behaviours with social support) lifestyle intervention (August 2008 & 2009) ◦ Monday – Friday 9am-4pm (children) ◦ Saturday family sessions 10am-2pm (guardians) ◦ Monthly post-intervention support – “Booster Sessions” Program details Week 1: Sports Week Week 2: Healthy Eating Around the Clock Week 3: Olympic Week Week 4: Adventure Week We strived to incorporate daily: o Aerobic activities o Resistance-training activities o Sports or fitness-based activities o Nutrition sessions o Educational sessions Research components 1) Initial Meeting (Western University) Letter of Information, Assent, Consent Demographic questionnaire Quality of Life (PedsQL 4.0)—child and parent reports Acticals (worn for 7 days) DXA Scan (body composition) 2) Bloodwork and Physical Assessment (Children’s Hospital) Fasting bloodwork (glucose, insulin, lipid panel) Physical Assessment (medical clearance) 3) Phone Conversation with C.H.A.M.P. Dietitian o Child’s Self-Efficacy Towards Healthy Living Questionnaire 4) First Day of C.H.A.M.P. o Physical Activity Questionnaire for Children (PAQ-C) o Fitness testing (Cooper 12 minute walk test) 5) Mid-C.H.A.M.P. Assessments o Weekly fidelity checks (children/guardians) o Cohesion/perceptions of belongingness 6) Focus Group Interviews o Conducted after the 4-week program o Separate focus groups for children and parents were conducted to explore and discuss the perceived impact of C.H.A.M.P. RESULTS: SELECTED CHILD OUTCOMES Significant ↑ in physical activity self-efficacy (6 months) (Burke et al., 2015) Significant ↑ in muscle mass and ↓ in body fat percentage (post-intervention) (Burke et al., 2015) Significant ↑ in children’s self-reported physical (6 months), social (6 months), and emotional (12 months) quality of life (Burke et al., 2015) Significant ↑ in parents’ perceptions of their child’s physical (12 months), social (12 months), and emotional (12 months) quality of life (Burke et al., 2015) Positive perceptions from parents (Pearson et al., 2013) and children (Pearson et al., 2012) RESULTS: PARENTAL INVOLVEMENT Mean child (91%) vs. parent (69%) attendance (Burke et al., 2015) Some parents expressed a desire for more involvement in the program (e.g., “…There should be a C.H.A.M.P camp for parents!”) Results: Focus group CHILDREN’S PERSPECTIVES – PERSONAL IMPACT o “Before C.H.A.M.P., it felt like I had like a big, big weights on my shoulders and everything was really hard... But now that C.H.A.M.P.’s over, I feel like those weights are off.” o “Well, basically I used to think I was really fat and people would call me it and then I’d feel bad... But now I know, I’m not the only one that is in that situation too... Now I know that I’m not the only one out there.” CHILDREN’S PERSPECTIVES – GROUP DYNAMICS/TEAM IMPACT o “They [the team] would always cheer you on. And like, one of my personal goals was to try my hardest, and don’t say that ‘I can’t’ and stuff... And, people would be sitting there, 'Come on ….! You can do it!’” o “[T]hey [campmates] don’t judge. Some people out of camp... they judge you for the way you look.” CHILDREN’S PERSPECTIVES – FUTURE RECOMMENDATIONS o “I would tell my friends, ‘It’s not awkward ‘cause everyone else is like you.’ And they’re all in this position and like it does, it really does help. Like... when my mom told me that she wanted me to go to it, I felt like, ‘Aaww, don’t make me do this... I don’t want to go, I’m fine the way I am.’ And then when I went, it changed. It changed me like, inside and out and I feel better about myself and it’s like we’re all a big family.” A Parent-Focused Lifestyle Intervention for Children with Obesity Parental Roles and Influences Parents are critical partners in childhood obesity treatments for several reasons: Primary decision makers about household food and meals Children learn lifestyle behaviours from their parents Parenting and feeding styles can influence children’s weight Parent-Focused Interventions Interventions targeting parents exclusively have been found to be at least as effective as child-only or parent-child interventions Parent-focused interventions may also be more costeffective than traditional family-based interventions WHAT IS C.H.A.M.P. FAMILIES? - A 13-week pilot intervention offered to parents and caregivers of children aged 6-14 years with overweight and obesity (i.e., BMI > 85th percentile for age and sex) in London, Ontario GROUP-BASED (PARENT-ONLY) COMPONENT 8, 90-minute group-based health education sessions for parents at a local YMCA Content delivered by researchers, health professionals, and community organizations Evidence-based materials, information, and resources provided at each session Comprehensive curriculum: Healthy eating, physical activity, sleep, screen time, sedentary behaviours, parental role modelling, marketing of foods and beverages to children, family communication and cohesion, bullying, stigma, effective parenting, and mental health HOME-BASED (FAMILY) COMPONENT Family goal setting and discussions related to health behaviours Worksheets assigned after each education session to reinforce concepts Worksheets were to be completed as a family, encouraging: 1. Family discussions about health 2. Family goal setting related to health behaviours - Worksheets were discussed as a group at the next education session FOLLOW-UP (FAMILY) COMPONENT 2, group-based “C.H.A.M.P. Families Booster Sessions” at 3- and 6-month post intervention Reiteration of intervention education related to healthy eating and physical activity in a fun, family-oriented, structured environment Opportunity for parents and children to reconnect and socialize with other families Provision of additional information related to community resources PURPOSE → To assess the impact of “C.H.A.M.P. Families” on: Children’s health-related quality of life Children’s physical activity levels and sedentary time Children’s standardized body mass index (BMI-z) Parental self-efficacy for supporting children’s health behaviours Overall perceptions of the program and its impact on family health and wellbeing (focus groups with parents and children) PARTICIPANT RECRUITMENT Parents were recruited via multiple strategies: Radio and newspaper advertisements Physician Referrals Posters Social media (i.e., Facebook and Twitter) DATA COLLECTION Data were collected at 4 time-points: 1. Baseline 2. Mid-intervention 3. Post-intervention 4. 6-month follow-up RESULTS Participants at baseline (n = 11 parents) o Drop-out (n = 1 parent) o Missing data (n = 1 parent) o Data collection complete (n = 9 parents) DEMOGRAPHIC INFORMATION Mean age = 41.5 years, SD=6.1 Female = 8 (88.9%) White/Caucasian = 7 (77.9%) Married = 6 (66.7%) University degree = 5 (55.6%) Employed, full time = 5 (55.6%) RESULTS: BMI-Z AND PARENTAL SELF-EFFICACY All but one C.H.A.M.P. Families participant experienced small improvements in child BMI-z and parental SE from baseline to post-intervention Overall, changes were not maintained 6-months after the intervention RESULTS: FOCUS GROUPS Overall, parents perceived C.H.A.M.P. Families to be a positive experience Parents were more confident in their role as “primary agent-of change” Parents found it challenging to communicate with children about their weight and health behaviours and expressed a need for practical tools and strategies Parents noted several positive health-related outcomes for children, families, and parents Some parents said that they would have liked more child involvement “I’m particular about what I buy [the] kids…. I’m more aware of what I’m doing to give them a better chance of becoming healthy so, and staying healthy.” →Participant 9, female “I think it made me concentrate more on what I was putting in front of my kids as food...” →Participant 1, female DISCUSSION Parents in both programs noted several benefits for their children, families, and themselves Underscored the importance and positive impact of the group environment Parents in both programs identified a desire for child and parental involvement, together or concurrently  Nutrition basics 6 years of eating In your lifetime, you will spend about 6 years eating (70 000 meals, 54 metric tons of food) What you eat can have profound effect on your health and wellbeing Nutritional habits can determine your risk of major chronic diseases, including hear disease, cancer, stroke, and diabetes Diet and nutrition An area in which you have high control Choosing a health diet involves: 1. Knowing which nutrients are necessary and in which amounts 2. Translating those requirements into a diet consisting of foods you enjoy and that are available/affordable Key points in lecture - Nutritional requirements - Nutritional guidelines - Nutrition labelling What we won’t talk about (except for right now) Fad diets, food documentries/ podcasts, or popular diet books WHY? There is no “one healthy way to eat” (or at least no way to truly test this) Often, such ‘extreemes’ demonize certain foods, and misrepresent science Generally speaking experts agree that certain “dietary patterns” seem to be healthier than others Foods and food groups can be combined in a variety of flexible ways to achieve health; can be tailored to meet individual health needs, preferences and cultural traditions Nutritional requirements Body require about 50 essential nutrients divided into 6 classes Essential → must get substances from food because body is unable to manufacture them (or not enough to meet physiological needs). The digestive system Body obtains nutrients through digestion Allows us to obtain these nutrients from our food Calories Energy in food expressed in kilocalories → 1 kilocalorie=1000 calories → 1 kilocalorie= amount of heat it takes to raise the temp of 1 litre of water to 1 degree C The word “calorie” generally stands for the larger energy unit Caloric needs to vary depending on age, body size, sex, activity level, whether one is pregnant or breastfeeding NUTRITIONAL REQUIREMENTS Three classes of essential nutrients supply energy: FAT = 9 calories per gram PROTEIN = 4 calories per gram CARBOHYDRATE = 4 calories per gram [ALCOHOL = 7 calories per gram] →Calorie intake > energy needs = converted to fat and stored in the body Proteins Promote growth and maintenance of muscle and connective tissue, povide energy (4 cals/g) Form important parts of blood enzymes, some hormones, cell membranes Composed of chains of amino acids (9 essential amino acids) Foods that contain all 9 essential amino acids are complete proteins Essential amino acids can be obtained from combinations of incomplete protein sources Fats (lipids) Provide a concentrated form of energy (9 cals/g) Give some foods a pleasing taste, texture Help absorption of fat-soluble vitamins Insulate our bodies to retain heat and provide a protective cushion for internal organs Essential fats include linoleic acid and alpha-linoleic acid Dietary fat consistant of a combination of 3 forms of fat based on chemical composition Saturated - Typically solid at room temperature - Found naturally in animal products (e.g meat, cheese) Monounsaturated - Typically liquid at room temperature - Usually from plant sources (e.g olive and canola oil) Polyunsaturated - Typically liquid at room temperature - Usually from plant sources (e.g soybean and corn oil) - Includes 2 essential fatty acids Trans fatty acids → unsaturated fatty acids with an atypical shape produced by hydrogenation - Used to increase stability of oil so it can be reused for deep frying, to improve texture of foods and to increase shelf life of foods - Leading sources=deep-fried foods, baked and snack foods, and stick margarine Fats (lipids) and heart health Low-density lipoprotein (LDL) - “bad cholesterol” - Saturated and trans fatty acids increase blood levels - Unsaturated fatty acids decrease blood levels High-density lipoprotein (HDL)-”good cholesterol” - Monounsaturated fatty acids may increase blood levels - Trans fatty acids (in large amounts) may decrease blood levels *Choose unsaturated fats instead of saturated and trans fats to decrease risk of heart disease Carbohydrates Various combinatinos of sugar units (saccharides) Used primarily for energy Classified as two groups: SIMPLE and COMPLEX Simple carbohydrates - Include sucrose (table sugar), fructose (fruit, sugar, honey), maltose (malt sugar), and lactose (milk sugar) Complex carbohydrates (starches) - Among the most important sources of dietary carbohydrates - Found primarily in grains, legumes, and tubers (potatoes, yams) - Unrefined (whole grain) complex carbohydrates are high in fibre, vitamins, minerals, and other compounds - Also take longer to chew and digest, enter bloodstream more slowly Refined carbohydrates versus whole grains All grains are whole grains before processing During processing, the germ and bran are removed leaving just the strachy endosperm The refinement of whole grains transforms whole wheat flour to white flour, brown rice to white rice Carbohydrates: fibre non digestible carbohydrates provided by plants Can decrease risk of Type 2 diabetes and heart disease, and increase gastrointestinal health Two types: Dietary fibre: - Present naturally in plants, such as grains, legumes, vegetables Functional fibre: - Isolated from natural sources or synthesized in a lab and added to foods/supplements Soluble vs insoluble fibre Soluble (“visous”) fibre - can delay stomach emptying, slow the movement of glucose intro the blood, and decrease Insoluble fibre - increase fecal bulk, helps prevent constipation, hemorrhoids, and other digestive disorders Vitamins Organic micronutrients required in small amounts for normal growth, reproduction, and maintenance of health (13 essential vitamins→4 fat-soluble, 9 water-soluble) Our bodies don’t manufacture most vitamins Often coenzymes , facilitating action of enzymes to help initiate a variety of body responses - Energy production - Use of minerals - Growth of health tissue Water-soluble vitamins Capable of being dissolved in water, absorbed directly into bloodstream 8 B-complex vitamins (thiamin, riboflavin, niacin, vitamin B-6, folate, vitamin B-12, biotin, pantothenic acid) and vitamin C In most cases, excess consumption results in elimination from the body in urine Important not to lose during preparation of fresh fruits and vegetables (ie. dont cook for too long or some vitamins may be lost) Fat-soluble vitamins Capable of being dissolved in fat or lipid tissue Vitamin A, D, E, K Excess consumption results in storage in liver and fat tissue Possible to consume/ retain toxic amounts, particularly vitamins A and D Minerals Inorganic micronutrients (non carbon containing)--> (17 essential minerals ) Critical in regulation of certain body processes, aid in the growth and maintenance of body tissues, and help release energy Major mineralors (“macrominerals”) - Body needs > 100mg per day - Examples: Calcium, phosphorous, magnesium, sulphur, sodium, potassium, chloride - Calcium difficult to obtain in adequate amounts if diet does not emphasize milk or dairy products Safest way to prevent mineral deficiency=a balanced diet Trace minerals - Body requires in minute amounts - Examples: Zinc, iron, copper, selenium, iodine, fluoride - Required in very small quantities but are essential for good health Water May be our most essential nutrient Used in digestion and absorption of food Provides medium for nutrient and waste transport Controls body temperature Functions in nearly all of the body’s chemical reactions Improving your eating habits article Common Barriers: Costs too much to eat well: Opt for generic brands, buy seasonal produce, use frozen or canned options, and plan meals with a grocery list. Hard to eat well when dining out: Choose water, smaller portions, and limit high-calorie items. Check nutritional info. Lack of time for meal prep: Plan meals, involve family, use time-saving items (e.g., frozen veggies), and prepare food in advance. Doubt about changing eating habits: Seek support, set realistic goals, make small, gradual changes, and celebrate successes. Expect setbacks and adjust timelines as needed. SMART Goal Setting: Specific: Clearly define your goal (e.g., eat more fruits and vegetables). Measurable: Set quantifiable steps (e.g., half of each meal will include vegetables). Achievable: Ensure the goal is realistic. Relevant: Choose goals that are meaningful and beneficial. Time-bound: Set a timeline for achieving the goal. Example of a SMART goal: Specific: Eat more fruits and vegetables. Measurable: Half of every meal will include fruits/vegetables. Achievable: Add one fruit to breakfast, two vegetables to lunch and dinner. Relevant: Choose fruits/vegetables you enjoy. Time-bound: Week-by-week progress (e.g., add fruit first week, vegetables next). Guidelines for health eating - OLDEST FOOD GUIDE: 1942, Canadas official food rules - These became Canadas food rules in 1942 and 1949 - Canadas food guide to eating in 1992 evolved to eating well with →Canadas food guide in 2007 - Lead to issues such as accessible cost to food and malnutrition - Suggested foods for daily consumption: milk, fruits, vegetables, cereals and bread, meat, fish and eggs - Limited supplies of food at some time leading to people only attaining 70% of the dietary standard “EATING WELL WITH CANADA’S FOOD GUIDE” Released in Feb 2007 Developed with ~7,000 dietitians, scientists, physicians, public health personnel Emphasized importance of combining physical activity with healthy eating →information on amount, types, and quality of food recommended for age and gender → includes groups: vegetables and fruits, grain products, milk and alternatives and meat and alternatives Revision of Canadas food guide From 2013-2015, evidence for dietary guidance was reviewed, revealing that: There were challenges in understanding/applying certain aspects (e.g., food guide servings, recommendations to make healthy meals/snacks) The format was not meeting the needs of all Canadians (e.g., some people preferred more detail, others wanted less) The scientific basis for the 2007 guide was consistent with latest evidence.  some topics needed changing/strengthening, such as: The replacement of saturated fat with unsaturated fat High intakes of sugar-sweetened beverages Some “guiding principles” released by Health Canada in June 2017 (consultations about 2019 food guide) They recommended: The regular intake of vegetables, fruit, whole grains, and protein-rich foods, especially plant-based sources of protein Eating foods that include mostly unsaturated fat (vs. saturated) Eating > plant-based foods (plant based eating implied as a core principle) ↓ intake of processed and prepared foods Avoiding processed beverages that are ↑ in sugar (soft drinks, fruit drinks) Sharing meals with family and friends Planning and preparing healthy meals and snacks Canadas food guide industry-conflict - Must ensure that the development of dietary guidance is free from conflict of interest Canadas food guide Released in January 2019 *Developed using high-quality scientific reports, excluding industrycommissioned reports No longer includes food groups or recommended serving sizes Proportion (plate) instead of portion/serving sizes Emphasizes fruits and vegetables, whole grains, protein, and food skills Context of eating in addition to nutrients Canadians encouraged to focus on: (1) what to eat regularly (2) what to avoid (3) the importance of preparing meals at home 2019 food guide → Canadas food guide-why does it matter? IF FOLLOWED, can lead to healthier diets, eating patterns, and health outcomes Food environment and food culture: School food policies and programs (e.g., sugar-sweetened beverages) Food served in nursing homes and hospitals Strengthen public health calls for food reform in public places Bolster efforts re: banning advertising to kids, front-of-package claims, nutrition fact panel changes Education in schools, provided to RDs/MDs, prenatal classes, etc. Heart and stroke foundation Aggressive marketing: Children are bombarded with food and beverage advertisements, primarily for unhealthy products high in sugar, salt, and fat. These ads are pervasive across various platforms, including TV, social media, video games, and even educational websites. Impact on health: Marketing shapes children's preferences, leading to poor dietary habits that increase the risk of obesity, heart disease, and diabetes. influence: Food companies target children with sophisticated techniques, exploiting their inability to critically evaluate marketing, and influencing family purchasing decisions through the "nag factor." 1. What did you learn about the marketing of unhealthy foods and beverages to children? Children are heavily targeted by food and beverage companies, with over 90% of ads promoting unhealthy products, contributing to poor eating habits and health outcomes​ 2. What can/should we do about it We should advocate for legislation that restricts the marketing of unhealthy foods to children, similar to successful measures taken in Quebec, while promoting public awareness and healthier food environments Nutrition labelling Became mandatory for all prepackaged foods in 2007; final amendments/ regulations published in 2016 Legislated information on nutrition labels includes 1. Nutrition facts table 2. Ingredient list 3. Nutrition claims 4. Front-of-package nutrition symbols Nutrition facts table Helps soncumers make informed choices Based on a specific amount of food - Compare to amount you eat Included calories, 13 nutrients, and % daily value Amount of food listed is NOT recommended serving Calories and core nutrients Always listed in the same order Calories→ if you eat more than the amount of food in the table, you will consume more calories than listed % daily value Provides a quick overview of nutrient profile Puts nutrients on same scale (0-100%) à allows product comparisons Quickly identify the strengths and weaknesses of a food product List of ingredients All ingredients listed in descending order by weight Ingredients present in greatest amounts listed first Helps consumer with food allergies or intolerances to avoid ingredients Nutrients such as saturated fats, sugar, and sodium may appear under different names Nutrition labelling: ongoing challenges EXAMPLES: Nutrition facts table Making serving sizes more consistent and realistic Increasing font size of serving sizes and calories Adding bold line under calories Adding a new % daily value for total sugars Adding potassium to list of nutrients List of ingredients Grouping sugar-based ingredients in brackets after the name ‘sugars’ in the list of ingredients Using bullets or commas to separate ingredients Front of package nutrition symbol Required on prepackaged foods that are high in one or more of: SODIUM, SUGARS, or SATURATED FAT Food industry has until January 1, 2026 to make this change  Breastfeeding Article: Mom says she was blocked from facebook over breastfeeding photo - Breastfeeding and public media - Photo was removed because it violated facebook standards Article: Breastfeeding in prime-time fictional television - Textual analysis: analyzes how many times breastfeeding occurs on these shows - Mostly portrayed breastfeeding only with infants, and as something that is easily done, does not focus on challenges or potential problems. Media does not portray the challenges of breastfeeding - Author found that some of these shows portrayed extended breastfeeding as something that is not acceptable - Shows also tend to sexualize breasts as depicted in these shows - Demonstration in lecture: clip from the show “friends” Joey and Chandler move away when the women is breastfeeding as if it is an “abnormal” action, as well as over sexualizing her when it should be a normal and natural action More about breastfeeding and the media: - Not just limited to social media - Example: time magazine → - Mostly negative comments - Critics argue that the image was overly sexual, emphasizing that the breast is for sexual appeal only and not for nutrition - Others argue that it was solely for shock marketing to draw people attention rather than focusing on the fundamentals of breastfeeding BREASTFEEDING: THE BASICS Human milk is species specific; mother makes milk that is perfectly suited to baby’s requirements for growth and development Breast milk is the ultimate ‘super food’ and the only single food for humans that can independently sustain life for the first 6 months after birth BREASTFEEDING: THE BASICS Breast milk provides all of the fluid and nutrients for optimal growth and development Protects the infant from bacteria and viruses the mother comes in contact with Breast milk adapts to the age of the infant Constantly changes to meet the infant’s nutritional needs Composition changes in the early postpartum period, from colostrum to mature milk “Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended by WHO as the perfect food for the newborn, and feeding should be initiated within the first hour after birth.” (WHO, 2020) Hormones involved in breastfeeding: - Estrogen - Progesterone - Prolactin (helps the breasts make milk) - Oxytoxin (nurturing hormone, has a calming effect, can decrease hormone levels) (released from posterior pituitary gland and causes contractions, often called the milk ejection reflex) *prolactin is low during preganancy but increases largely after birth, everytime someone breastfeeds they release prolactin and produces/stores more milk BREASTFEEDING RECOMMENDATIONS Early initiation of breastfeeding (within 1 hour after birth) Exclusive breastfeeding for the first 6 months of life Introduction of nutritionally-adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years or beyond BREASTFEEDING – GLOBAL FACTS - Globally, only 41% of infants < 6 months of age are exclusively breastfed - Has not improved in 2 decades Globally, 3 in 5 babies are not breastfeed in the first hour of life > 820,000 children could be saved yearly if all children 0-23 months were optimally breastfed The first 2 years are critical, as optimal nutrition during this time ↓ risk of morbidity and mortality, ↓ risk of chronic disease, and ↑ overall development GRAPH - Rates vary among different regions - Ie, eastern Canada has lower rates - Suggests that support to women with ongoing breastfeeding is essential THE BENEFITS OF BREASTFEEDING “Breastmilk is the ideal food for infants. It is safe, clean and contains antibodies which help protect against many common childhood illnesses. Breastmilk provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one third during the second year of life.” WHO, 2024 SHORT-TERM BENEFITS FOR BABY Breastfeeding is associated with a reduced risk of: 1) MORTALITY ↓ mortality among children who are malnourished Developing countries à infants who are not breastfed have ↑ rates of diarrhea and respiratory illnesses (both main causes of infant death) 2) DIARRHEA AND INFECTION Dose-response relationship between duration and exclusivity of breastfeeding and protection against diarrhea & many types of infections 3) SUDDEN INFANT DEATH SYNDROME (SIDS) Meta analysis shows that breastfeeding is shown to have a 36% decrease in SIDS 4) PAIN Not breastfeeding ↑ infants’ response to pain Analysis of 11 studies showed that both breastfeeding and human milk are pain relieving Has been found to be more effective than other measures (e.g., topical creams, maternal cuddling, massage) during infant vaccination injections *2016 study found that breastfeeding is more effective to relieve pain from vaccinations SKIN-SKIN CONTACT - Skin-skin contact, helps for mother and baby after birth - Recommended right after birth and two hours after breastfeeding - It was developed in Columbia in the late 1970s in response to high death rate of babies - Since then babies were discharged earlier due to better infant and parent contact and better cardiac functioning LONG-TERM BENEFITS FOR BABY Breastfeeding is associated with a reduced risk of: 1) SOME CHILDHOOD CANCERS Several studies have found ↑ risk of some childhood cancers when children have not been breastfed Data showing that breastfeeding is associated with a ↓ in the incidence of childhood leukemia Additional research needed 2) ASTHMA breastfeeding does cut the risk of asthma, says landmark study of 250 000 babies over 30 years Breastfeeding does protect children from asthma, major review found Researchers combined data from 117 scientific papers over 30 years Found breastfeeding cuts risk of asthma by 37% in infants under three And children aged seven or over were 17% less likely to have condition 3) INCREASED COGNITIVE DEVELOPMENT Breastfeeding children have been found to perform better on intelligence tests (WHO, 2024) Also associated with ↑ receptive language and verbal and nonverbal intelligence later in life 4) OVERWEIGHT AND OBESITY Many studies have shown a relationship between breastfeeding and obesity prevention Has been debated WHO: Children and adolescents who were breastfed as babies are less likely to be overweight or obese (2024) *many suggest that infants cannot be overfed with breastmilk, hence it wll not lead to obesity *Many other factors contribute to obesity which is why this is not a definite fact 5) TYPE 1 AND TYPE 2 DIABETES Breastfed children are less prone to developing diabetes later in life *Diabetes is multifactorial, breastfeeding can only help BENEFITS FOR MOTHER “Possibly, no other behaviour can affect such varied outcomes in the two individuals who are involved: the mother and the child” Victora et al., 2016, p. 485 BENEFITS FOR MOTHER Premature weaning or not breastfeeding are associated with health risks Degree to which health outcomes are realized depends on duration, frequency, and exclusivity of breastfeeding In many studies, associations are based on lifetime duration of Breastfeeding Breastfeeding is associated with a ↓ risk of: Breast and ovarian cancers (WHO, 2020) Hypertension, diabetes, hyperlipidemia, cardiovascular disease, metabolic syndrome Rheumatoid arthritis Postpartum depression Sleep disturbances Ted talk-Katie Hinde - Breastfeeding correlated to womens time and energy - Mothers milk fuels the babys bodies, feeding for two - Milk can also provide prevention to immune disease - Milk shapes behaviour and neurodevelopment and is often undermined by society - Mixture of breastmilk and baby saliva causes a chemical reaction that produces hydrogen peroxide - We are neglecting the importance of milk, and different varieties available to consumers (for example having milk as one size fits all) not acklogeding the disparities among boys and girl infants - Many biases exist between mother and clinician - Breast milk is a primary aid for survival for babies - We need to understand the importance of breastfeeding so that we can deliver better formulas for those in need Infant formula feeding “Overall…the data [are] clear that infants and young children who are fed formula are at an increased risk for compromised nutritional status, growth, and development and overall health and survival.” *infants who are not fed are at risk Important information/ cues about women who use formula To properly support women and families, it is important not to “demonize” infant formula or shame women who do not breastfeed Safe use of formula is an important goal recognized by the WHO for infants receiving infant formula (Abrams & Daniels, 2019) If it is not possible for a mother to exclusively breastfeed, parents/caregivers should be supported to ensure the infant's well-being  Provision of appropriate information on breastmilk substitutes FORMULA AND BOTTLE FEEDING: CONSIDERATIONS Powdered infant formula is not sterile and serves as an ideal substrate for bacterial growth Pathogen contamination → Cronobacter sakazakii and Salmonella enterica have been detected in commercially produced powdered infant formula and linked to outbreaks Proper preparation and storing of powdered infant formula can reduce the risk of illness Cleaning and sterilizing equipment also essential How to prepare a bottle feed *no need to memorize - Cleanand disinfect, wash hands, boil some water, read instructions… Multi-country outbreak of Salmonella infection - Linked to the consumption of infant formula in France, Belgium and Luxumbourg - All infants were infected with the same bacterial strain FORMULA AND BOTTLE FEEDING: CONSIDERATIONS ADULTERATION OF INFANT FORMULA 2008 → ~300,000 children in China became ill as a result of melamine added to infant formula by 22 companies; 6 deaths from acute renal failure Melamine added to disguise low protein content from diluting formula; ↑ apparent protein content and gave formula a milky appearance *Canada does not allow melamine to be used as a food ingredient *prohibitied as a food ingredient in Canada FEEDING IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES “Wherever possible, mothers and babies should remain together and get the support they need to exercise the most appropriate feeding option available. Breastfeeding remains the preferred mode of infant feeding in almost all difficult situations, for instance: Low-birth-weight or premature infants; Mothers living with HIV in settings where mortality due to diarrhea, pneumonia and malnutrition remain prevalent; Adolescent mothers; Infants and young children who are malnourished; and Families suffering the consequences of complex emergencies.”  Emergencies and disasters → widespread distribution of infant formula exposes infants to ↑ risk of disease and death when clean water is scarce for mixing formula and bottle washing UNICEF video - Breastfeeding is a vital response during emergencies - Although optimal feeding is hard to maintain during crisis - Rumours suggest that mothers cannot breastfeed under stress, but this is wrong emergencies can transfer into opportunities to promote the benefits of breastmilk - Shown in the disaster in Indonesia - In areas with high crisis rates, breastfeeding has increased from 10% to 30% The baby killer - The promotion of infant formula has a long history - War on Want is the first organization that drew attention to infant formula companies such as Nesle, leading to the unnecessary death caused by the aggressive marketing of infant formula - Muller explains how large corporations were causing infant illness, as they were also discouraging breastfeeding - Muller suggests that third world babies are dying because their mothers bottle feed them with Western style infant milk - They incorporate persuasive strategies to market this formula so that mothers give up breastfeeding Nestle Pakistan - Has stepped up to help families whose income has been impacted due to lockdown, Nestle has donated water, juices, Nido, Milk pack, Lactogrow, and Cerelac which will be distributed by PDMA - Nesle: worlds largest baby food company, sparked a global boycott due to their aggressive marketing of breast milk substitudes - Protest spread and the boycott was suspended in 1984 and resurfaced in 1980s when many other countries adopted it - In May 1978, Senator Edward Kennedy held a series of US senate hearings into the promotion of breastmilk substitutes in developing countries - A year later in 1979, the World Health Organization and UNICEF hosted an international meeting that called for the development of international code of marketing and other actions to improve infant feeding and other practices Senetor Edward Kennedy hearing of marketing of formula in developing countries in 1978 - Looking into the marketing practices of the baby industry - UNICEF and organization drafted a code to restrict the unethical practices of baby milk companies THE BABY FRIENDLY HOSPITAL INITIATIVE (BFHI) The Baby Friendly Hospital Initiative (BFHI) is a global initiative to promote, protect, and support breastfeeding Launched by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) in 1991 > 152 countries have implemented the BFHI HISTORY OF INFANT FEEDING 1920s – 1960s Canadian dairy industry grew and public health officials began to promote formula feeding Increase in feeding cow’s milk resulted in higher infant mortality rates → efforts to improve artificial baby milk rather than promotion of breastfeeding Campaign to educate mothers coincided with sharp ↓ in breastfeeding rates Many women in Canada abandoned breastfeeding Early 1970s Breastfeeding rates were ↑ in Canada and other Western nations, along with an ↑ recognition of the importance of breastfeeding in the health of the nation In developing regions, breastfeeding rates continued to ↓ à infant formula was marketed to mothers who could not afford it or were living in conditions that made formula preparation and feeding unsafe (e.g., diluting or using unclean water) Growing concern about the marketing of infant formula in developing 1979 WHO and UNICEF held an international meeting concerning infant and young child feeding (Geneva) 1981 The International Code of Marketing of Breast-Milk Substitutes was developed - WHO and UNICEF drafted this code, which was adopted by the World Health Assembly 1990 →Innocenti Declaration 1991 →Launching of the BFHI 2005 →Innocenti Declaration 2005 2006 →Revision of BFHI documents THE INTERNATIONAL CODE OF MARKETING OF BREAST-MILK SUBSTITUTES (THE “WHO CODE”) Provides minimum requirements to protect and promote appropriate infant and young child feeding practices Main focus is on the regulation of marketing of infant formula and products associated with bottle feeding Focuses attention on how the infant formula industry influences health care providers and consumers to support the use of manufactured baby milk SUMMARY OF THE WHO CODE 1. No advertising of breast-milk substitutes and other products to the public 2. No donations of breast-milk substitutes and supplies to maternity hospitals 3. No free samples to mothers 4. No promotion of products in the health services 5. No company personnel to advise mothers 6. No gifts or personal samples to health care workers 7. No use of space, equipment, or education materials sponsored or produced by companies when teaching mothers about infant feeding 8. No pictures of infants, or other pictures idealizing artificial feeding on the labels of products 9. Information to health workers should be scientific and factual 10. Information on artificial infant feeding, including on labels, should explain the benefits of breastfeeding and the costs and dangers associated with artificial feeding 11. Unsuitable products, such as sweetened condensed milk, should not be promoted for babies 12. Products should be of high quality and take into account the climatic and storage conditions of the country where they are used CANADA AND THE WHO CODE Canada gave its approval to the WHO Code in 1981 as part of near global consensus There continue to be many violations of the WHO Code as it is not legislated in Canada Violations of WHO code → - Promotions and sponsorships of infant formula products The gold standard - In these infant products there are no shortage of words that idealize infant feedings - Premiumization: products labelled as gold and premium - To showcare the use of additives of infant formulas being sold to families THE WHO CODE AND THE BFHI In Canada, the BFHI is called the Baby-Friendly Initiative (BFI) The Breastfeeding Committee for Canada (BCC) is the national authority for the BFI and adapts standards to the Canadian context Publicly funded maternity hospitals, birthing centres, and community health services (e.g., public health units) are eligible for BFI assessment and designation Agencies must follow the WHO Code and the 10 Steps outlined by WHO/UNICEF (2018) and adapted by the BCC to be BFI designated WHO/UNICEF “10 STEPS” TO SUCCESSFUL BREASTFEEDING STEP 1a: Comply fully with the International Code of Marketing of Breast-Milk Substitutes. STEP 1b: Have a written infant feeding policy that is routinely communicated to staff and parents STEP 2: Ensure that staff have sufficient knowledge, competence, and skills to support breastfeeding. STEP 3: Discuss the importance and management of breastfeeding with pregnant women and their families. STEP 4: Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth. STEP 5: Support mothers to initiate and maintain breastfeeding and manage common difficulties. STEP 6: Support mothers to breastfeed exclusively, unless supplements are medically indicated STEP 7: Enable mothers and their infants to remain together and to practice rooming-in 24 hours a day. STEP 8: Support mothers to recognize and respond to their infants’ cues for feeding. STEP 9: Counsel mothers on the use and risks of feeding bottles, teats, and pacifiers. STEP 10: Coordinate discharge so that parents and their infants have timely access to ongoing support and care. Breastfeeding and NICUs - Particularily harder for infants in NICU to get the ressources they need - Environmental scan: To determine different types of supports available to mothers and infants in Canadien NICU settings Ressources - Breastfeeding education, policies (ie skin to skin care), coordination of post discharge breastfeeding supports Male partners role in breastfeeding experience - Males were given a survey and asked what they perceived their roles to be in correlation to breastfeeding - Primary roles: supporting mother, caring for infant, feeding the infant, housework and preparing pump equipment BREASTFEEDING SUPPORTS AND SERVICES FOR MALE PARTNERS Education and access to partner-specific information on breastfeeding -“What to do for help when mom is breastfeeding” (Participant, T2) -“At the very beginning, it would be nice to have more easily accessible information to how a father can be more pertinent to breastfeeding” (Participant, T3) -“More info presented to the father prior to birth on the benefits of breastfeeding. I was unaware of the benefits until after he was born” (Participant, T3) Online or drop-in support group(s) for men -“As a stay at home dad, I would love a social networking/ "meet up group" of other parents ….” (Participant, T3) Alternatives to breastfeeding -“The focus is so much on [breastfeeding], there is no assistance should that not be possible” (Participant, T3) UNICEF and WHO Statement on World Breastfeeding Week ( July 31, 2024) Key Progress and Targets: Global exclusive breastfeeding rates for infants under six months have risen by over 10% in the last 12 years, now reaching 48%. This aligns with the WHO's goal to increase exclusive breastfeeding to at least 50% by 2025, saving hundreds of thousands of infants' lives. Health Benefits: Breastmilk provides vital antibodies that protect infants, especially in emergencies, from illness and death. For mothers, breastfeeding reduces the risk of specific cancers and noncommunicable diseases. Raising breastfeeding rates could save over 820,000 children’s lives annually. Theme for 2024: "Closing the gap: Breastfeeding support for all" Emphasizes the need for equitable breastfeeding support to promote maternal and infant health rights. Challenges and Needs: More than half the world’s population lacks access to essential health services, preventing many mothers from receiving optimal breastfeeding support. Only 50% of countries collect comprehensive breastfeeding data, which limits effective policy-making and targeted support. Actions for Improvement: Investment in Breastfeeding Programs: Allocate national budgets specifically for breastfeeding support. Family-Friendly Workplace Policies: Encourage paid maternity leave, breastfeeding breaks, and quality childcare access. Special Support for Vulnerable Communities: Provide tailored breastfeeding support for mothers in emergencies and underrepresented communities. Enhanced Data Monitoring: Improve data collection on breastfeeding and related policies to guide effective decisions. Regulation of Breast-Milk Substitutes Marketing: Implement and enforce laws restricting the marketing of substitutes, especially digital, and monitor for violations. About UNICEF and WHO: UNICEF operates in over 190 countries, focusing on children’s well-being and equity. WHO champions global health, connecting nations to expand healthcare access and respond to health emergencies worldwide.  Cancer reading Team Shan breast cancer awareness for young women - AYA Cancer Statistics globally 1.2 million AYA (15 -39 years) are diagnosed each year; 170,000 young women diagnosed with breast cancer; 43,000 deaths due to breast cancer; 9,000 AYA diagnosed yearly in Canada Breast cancer Higher incidence of cancer in younc women is attributed to breast cancer highest number of cancer deaths and disability adjusted life years (DALYs) attributed to breast cancer 1,300 young women diagnosed with breast cancer each year in Canada Age disparities no regular screening opportunities later stage diagnosis than older women more aggressive disease than older women; higher risk of inflammatory breast cancer than older women; more frequent recurrence rates; and poorer prognosis than older women More aggressive disease due to hormonal levels BCYW ‘Emerging issue’ This “increasing trend in the prevalence of breast cancer in young women, associated with poorer prognosis, more aggressive histologic features, and more frequent recurrence, makes it a rising threat to young women.” (Fernandez et al, 2023) Updates Help Seeking Barriers contextual barriers e.g., ethnicity; developmental barriers e.g., lack of awareness; emotional barriers e.g., lack of confidence; practical barriers e.g., too busy, and service barriers e.g., no doctor. Early Detection Improved Outcomes not just about mortality; decreased distress (anxiety, depression); TIME…quality time! time to live without cancer, time with family and friends, time to fulfill dreams. Updates young women, get breast cancer too Team Shan Updates AYA Cancer Research priorities for AYA cancer; High school lesson plans; HCP awareness and education initiative. Publications: https://canadianoncologynursingjournal.com/ index.php/conj/article/view/1254/1038 https://journals.lww.com/jporp/fulltext/2023/0 1000/_could_this_be_cancer___addressin g_diagnostic.1.aspx https://journals.lww.com/ywbc/fulltext/2024/0 1000/addressing_the_challenge_of_delay ed_diagnosis_due.11.aspx Team Shan… breast cancer awareness for young women Purpose to educate the public, health care professionals and young women about early detection, risk reduction and prevention of breast cancer Shan passed away in 2005 Aim to reach young women with their breast cancer risk and breast health information Health promotion OPHS Foundations Principles Need Impact Capacity Partnership & Collaboration Need: “if the incidence of a cancer is very low in the general population or in a demographic group (young women with breast cancer) they are often misdiagnosed or ignored” (CCS) Closing the Gap: A Strategic Plan AYA (Adolescence & Young Adults) Progress Review Group (LAF, 2006) - Looked at cancer prevention, diagnosis and treatment - Closing the gap report: American publication about cancer in yound adults Missed https://vimeo.com/7709192 - Stories of cancer survivors and some of the issues they encountered Reports cancer is the main cause of early death among young adult women almost two-thirds of young adult cancers occur in young women. Of these, breast cancer is the most common (CCS, 2006) there are relatively scant data to support either an environmental causation or an inherited predisposition to cancer in this age group at present, most cancer in this age group appears to be sporadic and random (SEER, 2007) What do these reports suggest? need to be aware, know their bodies, know their beasts, understand their risk and seek appropriate medical attention delays in diagnosis and treatment can be reduced by seeking regular and prompt medical care, especially if AYAs are aware of unusual changes to their skin, breasts or testes (CCS, 2009) little is known about the risk factors for many of the leading cancers in AYAs common symptoms are lumps in the neck, breast, abdomen and testicle as well as abnormal, pigmented skin lesions unfortunately, there may be delay in diagnosis (CCS, 2009) → more delay in young people - Looked upon the issue of adolescent cancer - Established provincial commuties and partnerships - Presenter lead the development of the fact sheet of young adolescent cancer - Potential years of life lost is 30% of total cancers 15-69 CPAC (2017) (2019) - Reports form the Canadien Partenership against Cancer one - Looked at the issue of adolescent Cancer in Canada - Looked at the issue of late diagnosis Delays in Diagnosis delays were attributed to either patients’ or physicians’ inaction physician reluctance to make a diagnosis assumed that age was a protective factor (Miedema, CFP, 2006) Don’t Let Youth Blind You to a Cancer Diagnosis (Medical Post, 2008) cancer in AYA population detected later than other age groups delays can be reduced by seeking regular and prompt medical care, especially if AYAs are aware of unusual changes to their skin, breasts or testes (CCS, 2009) because cancer is relatively uncommon among AYAs, awareness and suspicion of cancer is low and diagnosis can be delayed (CPAC, 2017) - “The diagnosis took time, very much so; I did not think I had a problem…I was young and did not think anything was serious; so did others. They tried to rule out other things first.” (CPAC, 2017) Statistics 15 -39 Years of Age about 8,600 adolescents and young adults (AYAs) are diagnosed with cancer in Canada each year over 1,200 young women diagnosed with breast cancer in Canada each year about 400 young women diagnosed with breast cancer in Ontario every year *males can also experience breast cancer →→→→ incidence of cancer in this age group increased steadily during the past quarter century (SEER, 2007) survival improvement tends portend a worse prognosis for young adults diagnosed with cancer today than 25 years ago (SEER, 2007) - Report helps raise awareness and getting the system to analyze things →→→ incidence of metastatic breast cancer in young women is increasing ( Johnson, JAMA, 2013) one out of eight women in Canada will face the disease in her lifetime (CCS, 2017) Team Shan - Shan, one young women in 2005 Literature Reviews Conclusions improving early detection of breast cancer can assist in reducing breast cancer deaths in young women no routine screening for young women to improve early detection rates in young women, this population must be aware of signs & symptoms of breast cancer in order to self-detect the disease Social Marketing Health related social marketing is… “the systematic application of marketing concepts and techniques to achieve specific behavioural goals, to improve health and reduce health inequalities” (French, Blair -Stevens) - Marketing to target young women with breast cancer Capacity Funding grants, donations and fundraising (annual events) Professional Expertise steering committee, board members, advisory, experts in the field graphic artist, epidemiologist, research consultant Partnerships & Collaboration host organization public health school boards high schools colleges and universities community Awareness & Education Activities-Team Shan public awareness campaigns including media & marketing strategies, print material distribution, presentations and sporting events high school, post secondary school classroom and assembly presentations. campus displays and sporting events community presentations and events print material distribution evaluation activities campaign interviews and publications Theme - Breast cancer…not just a disease of older women Messaging facts risk factors risk reduction symptoms self care prevention Breast Cancer poster FACTS - Young women are diagnozed with breast cancer every year in Canada (0ver 1200) - 1 in 8 women in Canada will face breast cancer in her lifetime - Cancer is the leading cause of premature death in young women BREAST CANCER IS THE MOST COMMON CANCER IN YOUNG CHILDREN (15-39 YEARS) - Most cancer in yound women appear to be random - Breast cancer in young women is often aggressive - Breast cancer does not always start as breast lump - Most breast lumps are not breast cancer - A lump that is consistent needs to be checked out since early detection is so critical. - Over 80% of breast cancers are present with breast lumps EARLY DETECTION SAVES LIVES - When diagnosed early there is usually better chance of successful treatment - Earlier diagnosis can occur when women report unusual breast changes to a doctor →Choices you make today may influence on your future risk of breast cancer UNCONTROLLABLE RISK FACTORS - Being female - Increased age - Born in North America or Northern Europe - Strong family history of breast or ovarian cancer - African heritage - Early start